Cases that require referral

and referral preparation

Retinopathy
Various disorders due to diabetes can occur in the
retina, ranging from non-proliferatif retinopathy to the
retinal hemorrhages, retinal detachments and further
may cause blindness.
- Need early diagnosis - retinal examination regularly
- Abnormalities in the retina are very varied. Some
circumstances require referral to a specialist eye
disease.
- References should as soon as possible:
Retinopathy proliferatif, rubeosis iridis / neurovascular
glaucoma, vitreous hemorrhage, retinopathy further
- References as early as possible: Changes in preproliferatif, maculopathy, decreased visual acuity of
more than two lines on the Snellen card
- Referral routine: cataract, diabetic retinopathy nonproliferatif that do not threaten the macula / fovea

Nephropathy
A decrease in glomerular filtration rate
function that leads to renal failure
requiring management with substitution
treatment
People with diabetes with renal
filtration rate <30 mL / min should
have been referred to a kidney disease
to explore and for the preparation of
therapeutic possibilities for a kidney
abnormalities, either later dialysis or
kidney transplantation

Coronary heart disease

- If there is a suspicion for example
discomfort in the chest area, should
all proceed with a screening tests to
look for the possibility of coronary
artery disease

Peripheral vascular disease

- Recognize and manage the various
risk factors related to the
occurrence of diabetic foot and
diabetic ulcers
- The changing shape of the foot,
neuropathy, a decrease in blood
supply to the legs is to look for and
note
- Foot care

Policies and basic principles

Based on the PMK No. 1 of 2012 Article 9,
Section said that health facilities can perform
vertical reference when patients require
health care specialist or sub-specialist and
the referrer can not provide health services
appropriate to the needs of patients due to
the limitations of facilities, equipment and /
or energy, not based on social indication.
Referral replay can also be given back if the
therapy by a specialist in hospital unfinished.

Based on the PMK No. 5 in 2014, said

that health centers should be able to
handle cases of DM-2 non-insulin
dependent, in the case of type 1 or 2
diabetes with insulin dependent
diabetes mellitus type or another and
Gestational Diabetes, the health
center is required to perform the
vertical referral to hospital.

In patients with newly diagnosed

type 2 diabetes, health centers can
refer to a specialist doctor at the
hospital to determine if there is a
complication of the disease, to
eventually get a referral back along
with therapies that can be
administered in the clinic.

After treatment for 2-3 months, new

patients can be referred back if the blood
sugar targets are not achieved by two
drugs and a healthy diet. However, if the
patient shows other diseases such as
KAD, nephropathy, neuropathy,
retinopathy, cardiomyopathy or diabetes
mellitus type 1 or 2 with insulindependent or gestational diabetes
patient can be referred to the hospital.

Modalities Referral Diabetes Cases

New 2 diabetes mellitus patients,
should be referred to determine
whether there is a complication of the
disease. If it is known that the patient
had no complications, the patient can
be treated for 2-3 months with
appropriate treatment guidelines that
exist on the previous page.

Criteria for referring to is the presence of

target organ damage or complications of
diabetes such as KAD, nephropathy,
neuropathy, retinopathy, cardiomyopathy
or diabetes mellitus type 1 or 2 with
insulin-dependent or gestational diabetes.
Type 2 diabetes without complications can
be referenced when after administration
of two drugs and a healthy diet of patients
did not improve for 2-3 months.